Many people don’t realize that many health care plans will cover drug treatment at little or no out of pocket cost. Most states (43 of them) have laws that require plans to cover drug rehabilitation. Because of the stigma associated with addiction, you may have to be prepared to challenge your health insurance carrier if they deny coverage. Some states find it difficult to enforce the laws regarding drug treatment because of this stigma. Keep in mind that group health insurance is required to comply with state law, but financially, it is beneficial for them to deny you coverage. Research your state laws before you contact your health insurance carrier and don’t take no for an answer. With the right attitude and information, you can find drug rehabilitation that your insurance will cover.
Every insurance plan is different, but those that cover substance abuse treatment will usually have different allocations for different parts of drug rehabilitation. For the detox phase, health insurance usually covers 3 to 10 days. It all depends on your assessment when you get into the detox facility and the drugs you were using. For example, when you are detoxing from drugs like alcohol and benzodiazepines, insurance will usually cover a safe medical detox, because the withdrawal from these drugs can be life-threatening. Not all insurance plans, however, will cover medical detox from opiates such as heroin or narcotic pain medication.
For inpatient treatment, insurance covers drug rehabilitation, on average, for 28-60 days. The treatment center is required to send the insurance detailed reports on your progress. Some insurance plans will cover a certain number of days up front, then reassess at the end of the covered period and decide whether it will continue to cover drug rehabilitation. Other insurance companies will only approve up to 3 days at a time. They will continue to check with the drug rehabilitation center to ensure that you need additional treatment before approving additional days. The facility that you attend will have ample experience in getting insurance to cover drug rehabilitation for additional days if they think you need it.
Many insurance plans also have a separate allocation for continuing care programs such as Intensive Outpatient Programs (IOP) or Outpatient Programs (OP). Some insurance providers even cover a stay in a halfway house. These programs are usually covered for a little longer than inpatient treatment. On average, insurance covers drug rehabilitation on an outpatient basis for around 6 months. Some health insurance plans will not cover IOP, but they will cover a certain number of sessions with a mental health counselor.
Even if insurance covers drug rehabilitation, there is likely a portion of treatment that they won’t pay for. Whether it is co-pays, deductibles, or simply additional costs while you are in treatment, there is usually a portion that you will have to pay yourself. Research your coverage before going to treatment and figure out what your cost will be. Usually the facility will be able to work with you.
If you or someone you know needs drug or alcohol treatment, call us at (877) 711-HOPE (4673) or visit us online at www.palmpartners.com.